Date Presented 04/04/19
This study, exploring the effects of an eight-week IADL group for people living with aphasia, identified statistically significant improvements in physical and communication skills and overall quality of life, as measured by the Stroke and Aphasia Quality of Life Scale and Community Integration Questionnaire. Positive trends were noted in home integration, social activities, and community integration. This research supports the unique value of OT and occupation-based groups for people with aphasia.
Primary Author and Speaker: Lynne Murphy
Additional Authors and Speakers: Lorelei Feeny, Danielle Matos
Contributing Authors: Nicole Falkenstein, Hanna Terry
PURPOSE: Aphasia often results in isolation, decreased community involvement, reduced IADL participation and dissatisfaction with quality of life. Group interventions for people with aphasia have improved communication and social skills; however, the connection to IADLs and quality of life has not been fully explored. This study was undertaken to determine if incorporating IADLs into group intervention may improve IADL participation in the home and community, and in quality of life. This research can address the unique role of OT for people with aphasia in resuming meaningful life activities.
DESIGN: This quasi-experimental study utilized a one group pre-test post-test design to explore the influence of an IADL group on IADL and community participation. Three participants were recruited from an existing community-based communication group facilitated by speech-language pathology students and faculty at a local university. The IADL group, facilitated by occupational therapy students and faculty, included cooking and woodworking projects and met for 8, 1-hour sessions.
METHOD: Two instruments were used as a pre-test and post-test. The Stroke and Aphasia Quality of Life Scale (SAQOL-39) groups occupational performance items into physical, communication and psychosocial domains and can be administered via interview and which includes adaptations to facilitate accurate answers for people with significant aphasia. The Community Integration Questionnaire assesses social roles related to home integration, social integration, and productive activity participation. Caregivers also completed questionnaires before and after the program to triangulate assessment data. The group met for 8 sessions between September 2017 and February 2018. Paired sample t-tests were used to analyze changes from pre-test to post-test scores.
RESULTS: SAQOL-39 identified statistically significant improvements in physical domain (t=-4.45, p=.05), communication domain (t=-6.76, p=.02) and overall quality of life (t=11.33, p=.01). Although psychosocial domain improved, it was not statistically significant. CIQ scores improved in home integration, social integration and total score; productivity score decreased. None of these changes were statistically significant. Although the small sample size may limit the generalizability of findings, the improved communication findings are consistent with literature. Although the improved physical skills were not a primary goal of the group, this is an area that is unique to OT and IADLs, and was not addressed in the existing communication group. The improved overall quality of life was consistent with general feedback from participants and caregivers, who expressed enjoyment of the IADL activities and interaction with the group leaders and members.
CONCLUSION: Although no significant differences were found in community integration, these improved scores and the significantly improved quality of life convey the unique contributions of occupational therapy for people living in the community with aphasia. Positive trends identified could be further explored through continued research, as well as increasing the sample size for this study.
IMPACT STATEMENT: Although speech therapy is often continued for people living in the community for extended time after acquired aphasia, this study supports the unique contributions of occupational therapy to improving quality of life and supports greater integration of occupations in the community.
References
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Mumby, K., & Whitworth, A. (2013). Adjustment processes in chronic aphasia after stroke: Exploring multiple perspectives in the context of a community-based intervention. Aphasiology, 27(4), 462-489. doi:10.1080/02687038.2013.772559
Roth, E. J., & Lovell, L. (2007). Community skill performance and its association with the ability to perform everyday tasks by stroke survivors one year following rehabilitation discharge. Topics in Stroke Rehabilitation, 14(1), 48-56. doi:10.1310/T520-4452-203L-1781
Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. American Journal of Occupational Therapy, 69, 1-15. http://dx.doi.org/10.5014/ajot.2015.012195
